Clinical presentations and management strategies of patients with oral lichen planus attending the Dental Teaching Hospital, Peradeniya

Abstract

Oral lichen planus (OLP) is a chronic inflammatory mucocutaneous disorder affecting 0.5- 2.2% of the population. Patients with OLP who presented to the Oral Medicine Clinic (OMC), Dental Teaching Hospital, Peradeniya from year 2000-2015 were included to this study. Clinical, histopathological and follow up data were gathered. The minimum follow up period was one month. All cases were classified clinically according to the classification of Andreasen. There were 361 females and 159 males with the male to female ratio of 1:2.3. The mean age at presentation was 45.11 years for males and 45.13 years for females. Age at diagnosis ranged from 8 to 89 years with a mean age of 45.13 years. The majority of patients were Sinhalese (88.5%). Reticular type was the commonest clinical type and accounted for 28.4% whilst buccal mucosa was the commonest site involved. Of the sample, 0.8% was treated with Chlorhexidine mouth wash and a mild topical corticosteroid whilst 35.4% were treated with Chlorhexidine mouth wash and a moderate topical corticosteroid drug. Intra- lesional corticosteroid drugs were used for 16 patients to relieve symptoms. Only 8 patients were managed without drugs. Complete resolution of symptoms was observed in 6% and the majority of patients had indicated that their symptoms had reduced (80%). A statistically significant association was found between age group and intra oral sites (p<0.001). No statistically significant association was observed between gender and clinical sub types (p=0.06) and also with type of treatment and outcome. Histopathologically, epithelial dysplasia was present in three cases at the initial diagnosis and these cases were followed up for 15, 17 and 35 months and they did not show malignant transformation (MT). Two cases of OLP without dysplasia at initial diagnosis later showed MT. They developed squamous cell carcinoma after 26 and 35 months. In conclusion, gender (female predominance), site (buccal mucosa) and type of OLP (reticular lesions) support findings from international literature. OLP is a condition with a low MT rate which requires long term follow-up even in the absence of dysplasia in the initial biopsy.